Esophageal replacement: overcoming the need.

Three developments which have contributed to the declining necessity for esophageal replacement are improvement in the management of esophageal atresia, prevention of caustic injuries to the esophagus, and early antireflux surgery for intractable gastro-esophageal reflux. Despite these advances, replacement of the esophagus may still be necessary. The two most commonly used procedures for replacing the esophagus are colonic interposition and gastric transposition. Experience with 236 gastric transposition operations reveals a mortality of 2.5%, leak rate of 12%, and stricture of 20%. The follow-up shows a satisfaction of over 90%. New methods of overcoming the need for esophageal replacement are in progress with tissue engineering with a scaffold to produce a tubular graft to bridge the gap in the continuity of the esophagus.